Provider Demographics
NPI:1558535575
Name:DEGREGORIE, CHRISTIANA DANIELLE (PSYD)
Entity Type:Individual
Prefix:
First Name:CHRISTIANA
Middle Name:DANIELLE
Last Name:DEGREGORIE
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2168
Mailing Address - Street 2:
Mailing Address - City:SPARTANBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29304-2168
Mailing Address - Country:US
Mailing Address - Phone:864-560-4304
Mailing Address - Fax:864-560-4413
Practice Address - Street 1:391 SERPENTINE DR
Practice Address - Street 2:SUITE 400, DOCTOR'S CENTER
Practice Address - City:SPARTANBURG
Practice Address - State:SC
Practice Address - Zip Code:29303-3096
Practice Address - Country:US
Practice Address - Phone:864-560-7517
Practice Address - Fax:864-560-7520
Is Sole Proprietor?:No
Enumeration Date:2008-04-22
Last Update Date:2011-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1079103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCP00882064OtherRAILROAD MEDICARE
SCPS0484Medicaid
NC6001257Medicaid
SCP00882064OtherRAILROAD MEDICARE